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abstract
Article history:
Objectives: This randomised, split-mouth clinical study evaluated the marginal quality of
direct Class I and Class II restorations made of microhybrid composite and applied using two
15 February 2013
Methods: A total of 50 patients (mean age: 33 years) received 100 direct Class I or Class II
restorations in premolars or molars. Three calibrated operators made the restorations. After
conditioning the tooth with 2-step etch-and-rinse adhesive, restorations were made incrementally using microhybrid composite (Tetric EvoCeram). Each layer was polymerised using
Keywords:
a polymerisation device operated either at regular mode (600650 mW/cm2 for 20 s) (RM) or
Clinical study
high-power (12001300 mW/cm2 for 10 s) mode (HPM). Two independent calibrated opera-
Composite
tors evaluated the restorations 1 week after restoration placement (baseline), at 6 months
and thereafter annually up to 5 years using modified USPHS and SQUACE criteria. Data were
Marginal quality
SQUACE
Results: Alfa scores (USPHS) for marginal adaptation (86% and 88% for RM and HPM,
Polymerisation
respectively) and marginal discoloration (88% and 88%, for RM and HPM, respectively)
RCT
did not show significant differences between the two-polymerisation protocols ( p > 0.05).
USPHS
Alfa scores (SQUACE) for marginal adaptation (88% and 88% for RM and HPM, respectively)
and marginal discoloration (94% and 94%, for RM and HPM, respectively) were also not
significantly different at 5th year ( p >0.05).
Conclusion: Regular and high-power polymerisation protocols had no influence on the
marginal quality of the microhybrid composite tested up to 5 years. Both modified USPHS
and SQUACE criteria confirmed that regardless of the polymerisation mode, marginal
quality of the restorations deteriorated compared to baseline.
# 2013 Elsevier Ltd. All rights reserved.
* Corresponding author at: Head of Dental Materials Unit, University of Zurich, Center for Dental and Oral Medicine, Clinic for Fixed and
Removable Prosthodontics and Dental Materials Science, Plattenstrasse 11, CH-8032, Zurich, Switzerland. Tel.: +41 44 63 45600;
fax: +41 44 63 44305.
zcan).
E-mail address: mutluozcan@hotmail.com (M. O
0300-5712/$ see front matter # 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jdent.2013.02.009
437
1.
Introduction
2.
2.1.
Study design
2.2.
Table 1 The brand, type, manufacturer, chemical composition and batch numbers of the main materials used in this
study.
Brand
Manufacturer
Chemical composition
Excite
2-step etch-and-rinse
adhesive resin
Type
Ivoclar Vivadent,
Schaan, Liechtenstein
Tetric EvoCeram
Microhybrid composite
Ivoclar Vivadent
Batch number
2006103145
RZD032
438
Fig. 1 Number of restorations placed by the operators and the work flow of the clinical study.
2.3.
Class
Polymerisation protocol
1
1
2
2
3
3
4
4
I
II
I
II
I
II
I
II
RM
HPM
HPM
RM
RM
HPM
HPM
RM
439
Marginal
discoloration
instructed not to do any margin adjustments on the restorations involved in this study.
2.4.
Evaluation
2.5.
Statistical analysis
Premolars
Molars
Total
Class I
Class I
Class II
Class II
RM
HPM
RM
HPM
5
20
25
5
20
25
13
12
25
13
12
25
Total
36
64
100
3.
Results
4.
Discussion
440
Table 5 Summaries of modified USPHS evaluations expressed in percentage at baseline and up to final follow-up for the
composite restorations polymerised using RM and HPM protocols.
Criteria
Marginal adaptation
RM
HPM
Marginal discoloration
RM
HPM
a
b
g
d
a
b
g
d
a
b
g
d
a
b
g
d
Baseline
6 months
1 year
2 years
3 years
4 years
5 years
94
6
0
0
94
6
0
0
98
2
0
0
100
0
0
0
94
6
0
0
94
6
0
0
98
2
0
0
100
0
0
0
94
6
0
0
94
6
0
0
98
2
0
0
98
2
0
0
92
18
0
0
94
6
0
0
98
2
0
0
98
2
0
0
88
12
0
0
90
10
0
0
94
6
0
0
94
6
0
0
84
16
0
0
88
12
0
0
92
18
0
0
90
10
0
0
86
14
0
0
88
12
0
0
88
12
0
0
88
12
0
0
Table 6 Summaries of SQUACE results expressed in percentage at baseline and up to final follow-up for the composite
restorations polymerised using RM and HPM protocols. Extension of the defect covering a) <10%, b) 1020%, c) 2030%, d)
3040%, e) 4050% and f) >50% of total restoration area.
Marginal adaptation
RM
HPM
Marginal discoloration
RM
HPM
a
b
g
d
a
b
g
d
a
b
g
d
a
b
g
d
Baseline
6 Months
94
4(a)2(b)
0
0
88
10(a)2(b)
0
0
98
2(a)
0
0
98
2(a)
0
0
94
4(a)2(b)
0
0
88
10(a)2(b)
0
0
98
2(a)
0
0
98
2(a)
0
0
1 year
2 years
3 years
4 years
5 years
92
4(a)4(b)
0
0
88
10(a)2(b)
0
0
96
4(a)
0
0
96
4(a)
0
0
92
4(a)4(b)
0
0
88
10(a)2(b)
0
0
94
6(a)
0
0
94
6(a)
0
0
90
6(a)4(b)
0
0
88
8(a)4(b)
0
0
94
6(a)
0
0
94
6(a)
0
0
90
6(a)4(b)
0
0
88
8(a)4(b)
0
0
94
6(a)
0
0
94
6(a)
0
0
88
8(a)4(b)
0
0
88
8(a)4(b)
0
0
94
6(a)
0
0
94
6(a)
0
0
2 1.8% (mean) for posterior composites. The results of a 3year prospective clinical study on 40 Class I and II restorations
using the same composite as in this study also did not report
any fractures, but 3 caries incidences. In that study, only RM
polymerisation protocol was applied and 38 restorations could
be followed.31 The lack of caries in 5 year follow up in this
study could be also attributed to strict maintenance programme for the practice setting.
Margin quality of the restorations indicated some deterioration compared to the baseline situation. At 5th year controls,
Alfa scores (USPHS) for marginal adaptation decreased from
94% to 86% and Beta scores increased from 6% to 14% using RM
polymerisation method. Similarly, using HPM method, Alfa
scores decreased from 98% to 88% and Beta scores increased
from 2% to 12%. Slight variations in the margin quality
between the studies could be in part due to the application of
adhesive resins or the polymerisation shrinkage of the
composite. The composite used was characterised with low
polymerisation shrinkage (1.6% v/v) and minimal accumulation of polymerisation stresses at the interface.31 In a
5.
Conclusions
441
Conflict of interest
The authors did not have any commercial interest in any of the
materials used in this study.
Acknowledgements
The authors acknowledge Drs. P.A. Acquaviva and L. Madini
for the evaluation of the restorations and Ivoclar Vivadent,
Schaan, Liechtenstein for generous provision of the adhesive
and composite materials.
references
442
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